目的：观察脊柱关节炎(SpA)患者外周血CD14+单核细胞Toll样受体2(TLR2)和Toll样受体4(TLR4)的表达变化及其与临床指标的关系,探讨其在SpA的发病中的作用。方法选择2008年7月~2009年1月蚌埠医学院第一附属医院风湿免疫科确诊SpA患者71例,并选择30名健康体检者作为正常对照组。采用流式细胞术检测外周血CD14+单核细胞表面TLR2、TLR4阳性细胞的表达的百分率及平均荧光强度(MFI)。根据BASDAI评分将SpA患者组分为活动组54例(BASDAI评分跃4分)和非活动组17例(BASDAI评分≤4分),分别比较活动组、非活动组和正常对照组三组间TLR2、TLR4阳性细胞表达百分率和MFI的差异,并分析TLR2、TLR4阳性细胞表达百分率和MFI与相关临床和实验室指标的相关性。结果 TLR2+外周血CD14+单核细胞的表面表达百分率在活动组、非活动组及正常对照组间差异无统计学意义(均P跃0.05)。 TLR2+外周血CD14+单核细胞表面MFI在各组间差异无统计学意义(均P跃0.05)。 TLR4+外周血CD14+单核细胞的表面表达的百分率在活动组和非活动组[(42.5±11.1)%、(32.9±9.4)%]与正常组相比[(22.3±7.5)%],差异有高度统计学意义(P<0.01),活动组和非活动组之间相比差异有高度统计学意义(P<0.01)。 TLR4+外周血CD14+单核细胞的MFI在各组间比较差异无统计学意义(均P跃0.05)。 TLR4+外周血CD14+单核细胞的表面表达的百分率与ESR和IgA呈正相关(P<0.05),TLR2+外周血CD14+单核细胞的表面表达的百分率与ESR和IgG呈正相关(P<0.05)。结论 TLR4在SpA患者外周血CD14+单核细胞表面表达有显著性变化,提示TLR4可能与SpA发生及病情存在一定的关联,TLR4和TLR2的表达可作为疾病活动度的参考指标。%Objective To investigate the effect and possible mechanism of Toll-like receptor-2 (TLR2) and Toll-like receptor-4 (TLR4) in the development and progress of spondyloarthropathy. Methods 71 SpA patients in the First Af-filiated Hospital of Bengbu Medical College from July 2008 to January 2009 were selected, and 26 cases of healthy controls were selected. SpA patients of 54 cases and 17 cases were divided into the active stage group and stable stage group, according to BASDAI score. Flow cytometry analysis was used to detect the expression of CD14+monocyte sur-face TLR2/4 positive cells, the TLR2 and TLR4 expression rate, the mean fluorenscence intensity (MFI) and the related clinical and laboratory indicators. Results There was no significant differences in the expression rate and MFI of TLR2 on CD14+ monocyte in the peripheral blood of SpA patients among the active stage group, stable stage group and healthy control group (P > 0.05). The expression rates of TLR4 in the CD14+ monocytes were [(42.5±11.1)%] and [(32.9±9.4)%] respectively in the active stage group and stable stage group, both were higher than that of control group [(22.3±7.5) %], there were significant differences among the three groups (P< 0.01), there was also significant differ-ence between the active stage group and stable stage group (P< 0.01). There was no significant differences in MFI of TLR4 on CD14+monocyte in the peripheral blood of SpA patients among the active stage group, stable stage group and healthy control group (P> 0.05). The expressiong rate of TLR4+correlated positively with ESR and IgA (P< 0.05), the expressiong rate of TLR2+ correlated positively with ESR and IgG (P < 0.05). Conclusion The expression pattern of TLR4 on CD14+ peripheral blood monocyte cells surface in SpA patients has significant changes. The results indicate that TLR4 play an important role in immune reaction of SpA. The expression of TLR2 and TLR4 in peripheral blood monocytes may help in assessing disease activity in SpA patients.
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